The Power of Promotores de Salud

On Twitter, NCLR joined @SaludToday for a #SaludTues Tweetchat on the power of promotores, who increasingly play an important role in promoting community-based health education and services for Latinos. See highlights from yesterday’s lively chat.
Continue reading

A Chat About the Role of Community Health Workers in Communities of Color: Highlights

Today NCLR joined our friends at Peers for Progress and Black Women’s Health Imperative for a twitter chat on how community health workers are vital to improving minority health. We’ve put together some highlights for you. Thanks to Black Women’s Health Imperative and Peers for Progress for working to produce this spirite Twitter chat today!

A Close Look at What ACA Navigators Do to Help People Get Covered

By David Castillo, New Media Manger, NCLR

An MHP Salud navigator helps a consumer throug the ACA enrollment process. Photo: MHP Salud

An MHP Salud navigator helps a consumer through the ACA enrollment process. Photo: MHP Salud

The thing to understand about Affordable Care Act (ACA) navigators is that they are busy people doing an important job: shepherding consumers through the enrollment process and helping them complete and file the application for financial assistance for lower insurance premiums. Navigators receive training from the Centers for Medicare and Medicaid Services and are then officially certified to provide impartial, in-person assistance. They offer a personal touch to a process that many find daunting, especially those who may have never had insurance before.

To get a sense of what these people do every day, we caught up with Cliff Clark, Program Director for NCLR Affiliate MHP Salud, which offers navigator assistance to the Rio Grande Valley. MHP Salud is a community-based organization that specializes in community health worker programs. It is currently in its second year of offering navigator services.

Together with his team, Clark serves a four-county area of more than one million people. Since open enrollment began in November, Clark has been busy traveling the massive region doing all he can to enroll as many as possible. He took me through an average day for a navigator in his area. “They might report to our offices in Weslaco, but they might also report to an off-site community partner that has made space available to enroll folks,” said Clark.

When a consumer arrives, the first thing the navigator does is begin an assessment that involves questions about family size, who in the family needs insurance, and what the consumer is looking to achieve. Based on this information, they begin creating an online profile for the enrollee and start the process of applying for financial assistance. This assistance comes in the form of a monthly tax credit, so navigators first collect information on income estimates to see if the enrollee qualifies. If the enrollee does, they can begin the process of selecting the right plan for their circumstances.

It is a lengthy process that depends on the customer’s understanding of insurance and often requires several visits. Helping people take the time to make the right decisions, however, is a top priority for Clark, and it’s something he stresses to his staff. “It’s not something you should rush,” he said. “You’re not going to buy a car with no wheels on it because it’s no use to you. It’s the same with insurance.”

MHPSaludLogoOne thing that sets MHP Salud apart is its use of community health workers, or promotores de salud, as navigators. In the Rio Grande Valley, providing culturally competent services is paramount, and promotores make folks much more comfortable. Clark notes that among those he serves, 85 percent of whom prefer to speak Spanish, the face-to-face contact is far more preferable to telephone assistance or online service, since technology can be a barrier to many of his customers.

“They’re more approachable, they’re a trusted part of our community,” said Clark of the promotores. “They live in the community, they know the challenges, and they understand the culture. That’s an extra layer of comfort that consumers have with our promotores.”

Also a boon this year is the outreach MHP Salud and many other groups have done to inform the public about what they need to enroll. As a result, Clark has found that many more clients now arrive with the documents needed to begin enrolling. It was a far cry from the first year, in which they often had to tell folks to return with the proper documentation.

“Before, they didn’t have anything with them because they just didn’t know. They were confused, perhaps a little frustrated because they felt obligated to do it,” said Clark. “People are coming in much more prepared this year.”

Of course, having all the documents needed to begin the process isn’t always a guarantee that people will receive coverage. This is especially true in Texas, which has failed to extend Medicaid coverage to low-income families, putting them in the “Medicaid coverage gap” because they make too much to qualify for Medicaid and too little to qualify for a subsidy. For Clark, it’s one of the more challenging aspects of the job.

He notes that only about 20 percent of the applicants MHP Salud assists actually qualify for a subsidy because their income level is between the eligibility limits. In such cases, consumers in the coverage gap receive an exemption to the law so they won’t be fined for not having insurance. But it also means they won’t have access to affordable insurance.


“Trying to explain the Texas Medicaid coverage gap to those who are terminally ill and why they can’t have access to health care has been very difficult,” said Clark. “It’s quite a bad situation.”

For the millions who fall into the coverage gap, many of them will do what they were doing before. “They’ll go to Mexico to see a doctor or go to a cash clinic, which is only $40,” said Clark. “Some will go to federally qualified health centers, which offer services to families with no insurance.”

He says he’s hopeful Medicaid will be expanded in Texas, or that at least an alternative solution will be offered, as it’s sorely needed in the area he serves.

Of course one of the more rewarding parts of Clark’s job is the flip side of that “bad situation.” He recalled one story of an elderly couple who received a 90 percent subsidy. It allowed one of them to receive long-needed cataract surgery, which they had put off because they had no insurance.

“Sometimes people come to tears of happiness because they have just been enrolled. They may be sick and really, really need it but didn’t think they could get insurance,” he said. “They are very pleasantly surprised when they find out they can start taking care of some things they need to take care of. It’s changing people’s lives.”

Cliff Clark and his ACA navigators at MHP Salud may be extremely busy people, especially with the enrollment deadline on the horizon, but they are performing a service vital to improving public health. And for that, we thank them.

The deadline to sign up for health care is Feb. 15. Don’t delay! Sign up today before it’s too late!

NCLR Hosts Conference on Community Health Worker Programs

This week, NCLR, along with Peers for Progress, a program of the American Academy of Family Physicians Foundation, hosted experts from across the country for a convening titled, “National Consensus Conference: Implementation and Dissemination Issues for Peer Support/Community Health Worker/Promotora de Salud Interventions and the Affordable Care Act”.

The National Peer Support Collaborative Learning Network, a collaboration of Peers for Progress and NCLR supported by the Bristol-Myers Squibb Foundation’s Together on Diabetes Initiative, has been the vehicle that for the work we have done over the last couple of years that we discussed during the convening.

For example, one of the objectives of the meeting was to review the Call to Action on Peer Support under the Affordable Care Act. Over the last several months, Harvard Center for Health Law Policy & Innovation, Peers for Progress, the Society of Behavioral Medicine, and NCLR drafted a Call to Action highlighting opportunities under the Affordable Care Act to integrate and implement peer support or community health worker programs into preventative services. We are currently seeking other organizations to endorse the document and help us to spread the word. If your organization is interest in endorsing this document, please contact Manuela McDonough at

Another objective of the convening was to organize visits with Representatives and Senators on Capitol Hill. We conducted visits with legislative staff from the offices of Senators Durbin, Franken, and Brown. It was great to meet with them to increase awareness and support of peer support/CHW programs and to advocate for continued funding of the Affordable Care Act.

Health Policy Spotlight: A Step Forward for Community Health Workers in Illinois

(This was originally posted to the Peers for Progress blog.)

HEALTH CR School 3By Clayton Velicer, MPH, Peers for Progress

As the United States healthcare system evolves under the new insurance exchanges and Affordable Care Act, more states are implementing programs that incorporate community health workers and peer support workers in an effort to reduce medical costs.

A number of programs in different states have recently been highlighted in our blogs, including a case study in New York that demonstrated cost-savings by integrating community health workers (CHWs) into patient centered medical homes, and Georgia’s statewide initiative to secure Medicaid reimbursements for peer support services in mental health.

In February, the state of Illinois took a step towards expanding the CHW workforce by proposing a bill to formalize their work and increase their funding. This blog will review the steps that led to this bill and look at some of the reactions from across the state.

Proposed Policy Changes in the Illinois Healthcare System

In January 2014, the Illinois Healthcare Reform Implementation Council produced a 43 page report filled with recommendations for policy changes in the state’s healthcare system. The importance of increasing the recognition and roles of CHWs is summarized in 5 of the 11 policy development recommendations that explicitly mention CHWs:

  1. Adopt the American Public Health Association’s definition of a Community Health Worker
  2. Establish a CHW State Advisory Board at the Illinois Department of Public Health to assist in the development of training, curriculum, and certification of CHWs. Members of the board should include: CHWs (at least 50% plus 1), CHW employers, educators, social services professionals, members of public health associations, health researchers, and members of the public.
  3. Support legislative action to formalize and standardize CHW training, curriculum and certification.
  4. Once developed, provide training at various levels of education and in diverse geographic settings, consider a tiered system of classifications within the CHW field, develop a “grandfathering” protocol for existing CHWs to ensure adequate levels of competency, and identify positions in the healthcare career ladder (nursing, physicians, consultants, etc.) that CHWs can transition into.
  5. Educate the spectrum of health professionals about the roles of CHWs. Many professionals are unclear about the roles of CHWs and how the ACA encourages the development and utilization of this workforce.

These recommendations are important because they establish a standardized definition (1), incorporate multiple stakeholders (2), propose advocacy steps (3), provide concrete examples of policies to advance the CHW workforce (4), and establish a campaign to build support for CHWs within the healthcare system (5).

Reactions to the Bill in Illinois

Media coverage of the bill shows support from a variety of key stakeholders. In an article in the Chicago Healthcare Daily, Dr. Lamar Hasbrouck, Director of the Illinois Department of Public Health, stated the value of CHWs:

“We need some foot soldiers in the community that are embraced, that are understood, that are familiar and can translate the jargon into real, actionable items”

Denise Bockwoldt, Director of Diabetes and Endocrinology Services for Sinai Health System, also affirmed the importance of CHWs, citing that they live in the same neighborhoods as their patients, can tailor care plans and give the system overall credibility. Sinai Health System treats a large uninsured and poor population and recently released a Best Practice Guidelines for Implementing and Evaluating Community Health Worker Programs.

Many hope that the proposed bill may create new funding opportunities. Under the current system, hospitals, clinics and other providers often pay for CHWs through short-term grant funding. Dr. Hasbrouck believes that creating a formal certification process will help providers understand the resources they’re getting and may make them more likely to fund workers from their own operating budgets. This may be even more convincing if insurers and government payors provide incentives to health care providers for improving care coordination.

Final Thoughts

We will be closely following this bill as it moves forward in Illinois, and we look forward to seeing how it impacts funding for CHWs and community health outcomes. We encourage our readers to share resources and media coverage of other states that are formally integrating CHWs and peer support workers into their state healthcare systems.